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General NPI Number Information
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NPI Number | 1558795682
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Entity Type | Individual
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Provider Name | LAURA A NEGIN
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Gender | Female
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Dates
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Enumeration Date | 08/26/2013
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 1461 E COOLEY DR STE 100
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City | COLTON
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State | CA
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Zip | 92324-3921
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Country | US
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Telephone | 909-809-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 S HARBOR BLVD STE 100
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City | SANTA ANA
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State | CA
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Zip | 92704-7915
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Country | US
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Telephone | 714-966-8670
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Fax | 714-434-0559
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 23954
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License Number State | CA
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